Urethral cancers are rare malignancies of the urethra, the tube that carries urine from the bladderA small, elastic/muscle type sac/bag in the body, where urine (wee) is stored for urinating/weeing. Is found in the lower abdomen/belly area. to outside of the body. The presentation of urethral cancerA disease where abnormal cells split without control and spread to other nearby body tissue and/or organs. Cancer cells can also spread to other parts of the body through the bloodstream and lymph systems. varies between men and women, due to differences in their anatomy and physiology.
In men, the urethra is approximatelyAbout or around the same, roughly or almost the same. 21cm long, and it runs from the end of the bladder to the urethral opening (opening to the outside of the body in the tip of the penis), carrying both urine and sperm. The most common type of urethral cancers in men are urothelial carcinomas (also known as transitional cell carcinomaA cancer that begins in the skin or in tissue that covers our inside body organs. – cancer arising from transitional cells
• the smallest, living parts of the body. Cells work together to form or build the body
• a human is made up of millions of Cells
• Cells reproduce themselves to make sure a body stays working
• sometimes Cells can be abnormal or damaged and these can be cancer cells
that line organs), followed by squamous cell carcinomas (cancer arising from squamous cells that line organs) and adenocarcinomas (cancer arising from mucus-producing glands in organs).
In women, the urethra is approximately 3-4cm long, and it runs from the end of the bladder to the urethral opening. It sits below the clitoris and above the vaginal opening, and carries only urine. The most common type of urethral cancers in women is squamous cell carcinomas, followed by urothelial carcinomas, and adenocarcinomas.
Urethral cancers are more common in men, and is most commonly found over the age of 60. However, anyone can develop this disease.
Treatment
If urethral cancer is detected, it will be staged and graded based on size, metastasisKnown as secondary cancer, it grows/spreads from the original/ primary cancer. (whether the cancer has spread to other parts of the body) and how the cancer cells look under the microscope. Staging and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumour) indicates the size and depth of the tumour.
- N (nodes) indicates whether the cancer has spread to nearby lymphA clear fluid that moves through the body through the lymphatic system, carrying cells that fight infection. nodes.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissue.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localisedOnly to one area/place of body. cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advancedAt a late stage, far along or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Grade
• A score that tells how quickly a tumour might spread and grow by looking at how the abnormal cells and tissue look under a microscope.
• Grade is not the same as stage.
• Grading is different depending on the type of cancer.
I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour. - Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including sex, location, stage of disease and overall health.
Treatment options for men include:
- Surgerytreatment involving removal of cancerous tissue and/or tumours and a margin of healthy tissue around it to reduce recurrence, potentially including:
- Endoscopic resection (removal of cancer only via long tube down the throat (endoscopeVery small(fibre optic) camera on a flexible tube for looking inside body organs.)).
- Transurethral resection (TUR) (removal of cancer via special tool inserted into the urethra).
- Urethrectomy (partial or total removal of the urethra).
- Penectomy (partial or total removal of the penis).
- Lymphadenectomy (removal of affected lymph nodes).
- Cystourethrectomy (removal of the bladder and urethra).
- Cystoprostatectomy (removal of the bladder and prostate).
- Urinary diversion (creating a new pathway for urine to exit the body when urine flow is blocked).
- Ostomy/urostomy (creating an opening in the abdomenstomach, stomach area, belly, tummy made to redirect urine away from a bladder that isn’t working).
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells.
- Chemotherapy
• a chemical drug treatment to kill or slow-growing cancer Cells
• these drugs are called cytotoxic drugs
. - Watch and waitthe close monitoring of a cancer without giving treatment until symptoms appear or worsen.
- Clinical trials.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
Treatment options for women include:
- Surgery, potentially including:
- Endoscopic resection (removal of cancer only via long tube down the throat (endoscope)).
- Transurethral resection (TUR) (removal of cancer via special tool inserted into the urethra).
- Urethrectomy (partial or total removal of the urethra).
- Lymphadenectomy (removal of affected lymph nodes).
- Cystourethrectomy (removal of the bladder and urethra).
- Vaginectomy (partial or total removal of the vagina).
- Pelvic exenteration (surgery to remove the urethra, bladder, and vagina).
- Urinary diversion (creating a new pathway for urine to exit the body when urine flow is blocked).
- Ostomy/urostomy (creating an opening in the abdomen made to redirect urine away from a bladder that isn’t working).
- Radiation therapy.
- Chemotherapy.
- Watch and wait.
- Clinical trials.
- Palliative care.
For more information on the treatment options, please refer to the Rare Cancers Australia treatment options page.
Urethral Cancer Treatment and Fertility
Some treatment for urethral cancer may make it difficult to conceive or carry a child. If fertility is important to you, discuss your options with your doctor and a fertility specialist prior to the commencement of treatment.
Risk factors
While the cause of urethral cancer remains unknown, the following factors may increase the risk of developing the disease:
- Having a personal or family history of bladder, ureter and/or renal pelvis cancers.
- Having conditions that cause chronicA long-lasting disease that changes slowly. inflammation in the urethra, including:
- Sexually transmitted diseases (STDs), including human papillomavirus (HPV).
- Frequent urinary tract infections (UTIs).
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Some of the information regarding risk factors was obtained from the Urethral Cancer—Patient Version page published by the National Cancer Institute.
Symptoms
Symptoms often present differently in men and women.
In men, symptoms of urethral cancer may include:
- Urethral strictures, which carries its own set of symptoms:
- Decreased urine stream.
- Feeling like you need to urinate after urinating.
- Difficulty, straining and/or pain while urinating.
- Frequent urination.
- Frequent urinary tract infections (UTIs).
- Bloodhello in urine.
- Dysuria (burning, tingling and/or stinging of the urethra when urinating).
- Unusual discharge
• Going home or leaving the hospital.
• Fluid coming out of a wound or body part.
. - Genital swelling.
- Priapism (prolonged penile erection).
- Abscesses in the urethra.
- Fistulas.
- Constipation.
- A lump in the penis.
In women, symptoms of urethral cancer may include:
- Irritative voiding, which carries its own set of symptoms:
- Frequent urination.
- Painful urination.
- Urinary incontinenceNot able to hold or control release of urine (wee/pee) or faeces (stools/poo)..
- Blood in urine.
- Pain during or after intercourse.
Not everyone with the symptoms above will have cancer but see your general practitioner (GP) if you are concerned.
Diagnosis/diagnosing
If your doctor suspects you have urethral cancer, they will order a range of diagnostic tests to confirm the diagnosisUsing medical test results, identify and name a disease and/or condition., and refer you to a specialist for treatment.
Physical examination
Your doctor will collect your overall medical history, as well as your current symptoms. Following this, they may examine your body to check for any abnormalities.
Pelvic examination
The doctor will inspect the abdomen for any swelling or masses, followed by your genitalia. The doctor will then insert two fingers into your vagina while simultaneously pressing on your abdomen with their other hand to feel your uterus and ovaries. Following this, the doctor may use a device called a speculum into your vagina, which will separate the vaginal walls and allow viewing of your vaginal canal and cervix for any visible abnormalities. You many request a family member, friend, or nurse to be present during this exam.
Digital rectal examination (DRE)
A digital rectal examinationan examination conducted by a urologist where a finger (or digit) is inserted into the rectum to feel the anus (DREDigital rectal exam, meaning to use a finger to probe inside the anus (bum; bottom; back passage) to examine it (to find cancer.) is an exam conducted by a urologist (a doctor specialising in issues pertaining to the kidneys, bladder, prostate, and male reproductive system). In this exam, the doctor will insert a finger (or ‘digit’) into your rectum to feel the back of your prostate. If it feels hard or is an odd shape, further testing may be required.
Imaging tests
The doctor will take images of your body using magnetic resonance imagingTaking images/photos of inside body parts using magnet rather than x-ray. (MRITaking images/photos of inside body parts using magnet rather than x-ray.), a computed tomography scan (CT scanA 3-D (three dimensional) x-ray pictures that gives more information than a normal x-ray.), x-ray and/or ultrasound, depending on where it is suspected the cancer is. The doctor may also look at other parts of the body and looks for signs of metastasis.
Blood & Urine tests
Urine and blood teststesting done to measure the levels of certain substances in the blood are used to assessTo measure, look at and learn from. overall health and detect any abnormalities. Some of these tests may include:
- General blood test to assess overall health.
- Full blood countA test that counts red blood cells, white blood cells and platelets in the blood., which measures the levels of red blood cells, white blood cells and plateletsSmall blood cells (shaped like plates) whose job it is to come together in a group(s) or clump(s) to stop bleeding when you are injured or cut..
- Blood chemistry and/or blood hormoneA chemical made in different body parts/organs that is sent out to other parts of the body through the bloodstream. Hormones watch over and help control how other cells or organs act. studies, which analyse the levels of certain hormones and other substances in the blood.
- Urinalysis.
- Urine cytology.
Ureteroscopy & Biopsy
A ureteroscopy is a surgical procedure that involves inserting a long, flexible tube with a light and small camera (uretoscope) through the urethra into the renal pelvis, bladder, and ureters. You will be given a sedative or anaestheticA drug used to get rid of or reduce the feeling of pain by putting you to sleep throughout the procedure. You will be asked to fast for several hours prior to the procedure. An endoscopyLooking inside the body with an endoscope. is often done as a day surgery. Your doctor will discuss the risks and any possible complications prior to the procedure.
Once the location(s) of the cancer has been identified, the doctor will perform a biopsyremoval of a section of tissue to analyse for cancer cells to remove a section of tissue using a needle. The tissue sample will then be analysed for cancer cells.
